A client newly diagnosed with diabetes mellitus suddenly becomes confused and weak. Which intervention(s) should the nurse implement? Select all that apply.

Check the client's current fingerstick blood glucose.

Obtain blood pressure and heart rate.

Administer a PRN dose of regular insulin.

Give the client 4 ounces (120 mL) of orange juice.

Provide the client with 1/2 cup (120 mL) diet carbonated soda.

Answer and Explanation

Correct Answer : A,D

Choice A reason: Checking the client's current fingerstick blood glucose is important to determine if the confusion and weakness are due to hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

Choice B reason: Obtaining blood pressure and heart rate is useful for a general assessment but is secondary to assessing blood glucose levels in this scenario.

Choice C reason: Administering a PRN dose of regular insulin is not appropriate without first determining the client's blood glucose level. If the client is hypoglycemic, insulin could worsen the condition.

Choice D reason: Giving the client 4 ounces (120 mL) of orange juice is a quick way to raise blood sugar levels if the client is hypoglycemic.

Choice E reason: Providing diet carbonated soda is not effective for treating hypoglycemia because it does not contain sugar to raise blood glucose levels.

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Correct Answer is ["A","D"]

Explanation

Choice A reason: Tolerating oral medications without vomiting is essential for discharge to ensure the client can manage pain and take necessary medications at home.

Choice B reason: While vital signs are important, the slightly elevated blood pressure alone may not prevent discharge if other criteria are met.

Choice C reason: A pain rating of 5 managed with oral analgesics is acceptable for discharge if the client can manage pain at home.

Choice D reason: Being able to ambulate to the bathroom safely is crucial for discharge to ensure the client can independently manage basic needs.

Choice E reason: Bowel sounds and a soft abdomen are important but are not the primary criteria for discharge in this context.

A. Evaluate the UAP for signs of improvement. B. Discuss the issue privately with the UAP. C. Note date and time of the behavior. D. Plan for scheduled break times.

Correct Answer is C,B,D,A

Explanation

The correct order is:

Note date and time of the behavior.
Discuss the issue privately with the UAP.
Plan for scheduled break times.
Evaluate the UAP for signs of improvement.

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A client newly diagnosed with diabetes mellitus suddenly becomes confused and weak. Which intervention(s) should the nurse implement? Select all that apply.

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Naxlex Comprehensive Predictor Exams

A client who fell and broke a wrist is admitted for 24-hour observation after emergency orthopedic surgery. The healthcare provider prescribes discharge in the morning. Which finding(s) should the nurse use to evaluate the client's status for discharge from the hospital? Select all that apply.

Correct Answer is ["A","D"]

Explanation

An unlicensed assistive personnel (UAP) leaves the unit without notifying the staff. In which order should the unit manager implement these interventions to address the UAP's behavior? (Place the actions in order from first on top to last on bottom.)

Correct Answer is C,B,D,A

Explanation

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